Health technology assessment in Australia : insights for China

 Keynote Speaker

Closed loop deep brain stimulation: an evolving technology

Deep brain stimulation is an effective and safe medical treatment for a variety of neurological and psychiatric disorders including Parkinson's disease, essential tremor, dystonia, and treatment resistant obsessive compulsive disorder. A closed loop deep brain stimulation (CLDBS) system automatically adjusts stimulation parameters by the brain response in real time. The CLDBS continues to evolve due to the advancement in the brain stimulation technologies. This paper provides a study on the existing systems developed for CLDBS. It highlights the issues associated with CLDBS systems including feedback signal recording and processing, stimulation parameters setting, control algorithm, wireless telemetry, size, and power consumption. The benefits and limitations of the existing CLDBS systems are also presented. Whilst robust clinical proof of the benefits of the technology remains to be achieved, it has the potential to offer several advantages over open loop DBS. The CLDBS can improve efficiency and efficacy of therapy, eliminate lengthy start-up period for programming and adjustment, provide a personalized treatment, and make parameters setting automatic and adaptive.

Robust real-time bio-kinematic movement tracking using multiple kinects for tele-rehabilitation

This paper investigates the robust and accurate capture of human joint poses and bio-kinematic movements for exercise monitoring in real-time tele-rehabilitation applications. Recently developed model-based estimation ideas are used to improve the accuracy, robustness, and real-time characteristics considered vital for applications, where affordability and domestic use are the primary focus. We use the spatial diversity of the arbitrarily positioned Microsoft Kinect receivers to improve the reliability and promote the uptake of the concept. The skeleton-based information is fused to enhance accuracy and robustness, critical for biomedical applications. A specific version of a robust Kalman filter (KF) in a linear framework is employed to ensure superior estimator convergence and real-time use, compared to other commonly used filters. The algorithmic development was conducted in a generic form and computer simulations were conducted to verify our assertions. Hardware implementations were carried out to test the viability of the proposed state estimator in terms of the core requirements of reliability, accuracy, and real-time use. Performance of the overall system implemented in an information fusion context was evaluated against the commercially available and industry standard Vicon system for different exercise routines, producing comparable results with much less infrastructure and financial investment.

Mobile health (mHealth) biomedical imaging paradigm

Technology assisted methods for medical diagnosis and biomedical health monitoring are rapidly shifting from classical invasive methods to handheld-based non-invasive approaches. Biomedical imagining is one of the most prominent practices of non-invasive mechanisms in medical applications. This paper considers the medical imaging schemes for Mobile Health (mHealth) applications and studies the feasibility of future mobile systems for accommodating image informatics capabilities.

Layer-by-layer assembly of silica nanoparticles on 3D fibrous scaffolds : enhancement of osteoblast cell adhesion, proliferation, and differentiation

Silica nanoparticles were applied onto the fiber surface of an interbonded three-dimensional polycaprolactone fibrous tissue scaffold by an electrostatic layer-by-layer self-assembly technique. The nanoparticle layer was found to improve the fiber wettability and surface roughness. Osteoblast cells were cultured on the fibrous scaffolds to evaluate the biological compatibility. The silica nanoparticle coated scaffold showed enhanced cell attachment, proliferation, and alkaline phosphatase activities. The overall results suggested that interbonded fibrous scaffold with silica nanoparticulate coating could be a promising scaffolding candidate for various applications in bone repair and regeneration.

Thermomechanical properties of Ni-Ti shape memory wires containing nanoscale precipitates induced by stress-assisted ageing.

This paper systematically examines the thermomechanical properties and phase transformation behaviour of slightly Ni-rich Ni-Ti biomedical shape memory wires containing homogeneously distributed nanoscale precipitates induced by stress-assisted ageing. In contrast to previous studies, particular attention is paid to the role of precipitates in impeding twin boundary movement (TBM) and its underlying mechanisms. The size and volume fraction of precipitates are altered by changing the ageing time. The martensitic transformation temperatures increase with prolonged ageing time, whereas the R-phase transformation temperature remains relatively unchanged. The stress-strain behaviour in different phase regions during both cooling and heating is comprehensively examined, and the underlying mechanisms for the temperature- and thermal-history-dependent behaviour are elucidated with the help of the established stress-temperature phase diagram. The effect of precipitates on TBM is explored by mechanical testing at 133K. It is revealed that the critical stress for TBM (σcr) increases with increasing ageing time. There is a considerable increase of 104MPa in σcr in the sample aged at 773K for 120min under 70MPa compared with the solution-treated sample, owing to the presence of precipitates. The Orowan strengthening model of twinning dislocations is insufficient to account for this increase in σcr. The back stress generation is the predominant mechanism for the interactions between precipitates and twin boundaries during TBM that give rise to the increase in σcr. Such results provide new insights into the thermomechanical properties of precipitate containing Ni-Ti biomedical shape memory wires, which are instructive for developing high-performance biomedical shape memory alloys.

Lubricin: a versatile, biological anti-adhesive with properties comparable to polyethylene glycol

Lubricin is a glycoprotein found in articular joints which has been recognized as being an important biological boundary lubricant molecule. Besides providing lubrication, we demonstrate, using a quartz crystal microbalance, that lubricin also exhibits anti-adhesive properties and is highly effective at preventing the non-specific adsorption of representative globular proteins and constituents of blood plasma. This impressive anti-adhesive property, combined with lubricin's ability to readily self-assemble to form dense, highly stable telechelic polymer brush layers on virtually any substrates, and its innate biocompatibility, makes it an attractive candidate for anti-adhesive and anti-fouling coatings. We show that coatings of lubricin protein are as effective as, or better than, self-assembled monolayers of polyethylene glycol over a wide range of pH and that this provides a simple, versatile, highly stable, and highly effective method of controlling unwanted adhesion to surfaces.

A new design concept for knitted external vein-graft support mesh

Autologous vein-graft failure significantly limits the long-term efficacy of coronary artery bypass procedures. The major cause behind this complication is biomechanical mismatch between the vein and coronary artery. The implanted vein experiences a sudden increase (10-12 fold) in luminal pressures. The resulting vein over-distension or 'ballooning' initiates wall thickening phenomenon and ultimate occlusion. Therefore, a primary goal in improving the longevity of a coronary bypass procedure is to inhibit vein over-distension using mechanical constriction. The idea of using an external vein-graft support mesh has demonstrated sustained benefits and wide acceptance in experimental studies. Nitinol based knitted structures have offered more promising mechanical features than other mesh designs owing to their unique loosely looped construction. However, the conventional plain knit construction still exhibits limitations (radial compliance, deployment ease, flexibility, and bending stresses) which limit this design from proving its real clinical advantage. The new knitted mesh design presented in this study is based on the concept of composite knitting utilising high modulus (nitinol and polyester) and low modulus (polyurethane) material components. The experimental comparison of the new design with a plain knit design demonstrated significant improvement in biomechanical (compliance, flexibility, extensibility, viscoelasticity) and procedural (deployment limit) parameters. The results are indicative of the promising role of new mesh in restoring the lost compliance and pulsatility of vein-graft at high arterial pressures. This way it can assist in controlled vein-graft remodelling and stepwise restoration of vein mechanical homoeostasis. Also, improvement in deployment limit parameter offers more flexibility for a surgeon to use a wide range of vein diameters, which may otherwise be rendered unusable for a plain knit mesh.

Evaluation of polyvinyl alcohol composite membranes containing collagen and bone particles

Composite biomaterials provide alternative materials that improve on the properties of the individual components and can be used to replace or restore damaged or diseased tissues. Typically, a composite biomaterial consists of a matrix, often a polymer, with one or more fillers that can be made up of particles, sheets or fibres. The polymer matrix can be chosen from a wide range of compositions and can be fabricated easily and rapidly into complex shapes and structures. In the present study we have examined three size fractions of collagen-containing particles embedded at up to 60% w/w in a poly(vinyl alcohol) (PVA) matrix. The particles used were bone particles, which are a mineral-collagen composite and demineralised bone, which gives naturally cross-linked collagen particles. SEM showed well dispersed particles in the PVA matrix for all concentrations and sizes of particles, with FTIR suggesting collagen to PVA hydrogen bonding. Tg of membranes shifted to a slightly lower temperature with increasing collagen content, along with a minor amount of melting point depression. The modulus and tensile strength of membranes were improved with the addition of both particles up to 10 wt%, and were clearly strengthened by the addition, although this effect decreased with higher collagen loadings. Elongation at break decreased with collagen content. Cell adhesion to the membranes was observed associated with the collagen particles, indicating a lack of cytotoxicity.

Comparative acoustic performance and mechanical properties of silk membranes for the repair of chronic tympanic membrane perforations

The acoustic and mechanical properties of silk membranes of different thicknesses were tested to determine their suitability as a repair material for tympanic membrane perforations. Membranes of different thickness (10-100μm) were tested to determine their frequency response and their resistance to pressure loads in a simulated ear canal model. Their mechanical rigidity to pressure loads was confirmed by tensile testing. These membranes were tested alongside animal cartilage, currently the strongest available myringoplasty graft as well as paper, which is commonly used for simpler procedures. Silk membranes showed resonant frequencies within the human hearing range and a higher vibrational amplitude than cartilage, suggesting that silk may offer good acoustic energy transfer characteristics. Silk membranes were also highly resistant to simulated pressure changes in the middle ear, suggesting they can resist retraction, a common cause of graft failure resulting from chronic negative pressures in the middle ear. Part of this strength can be explained by the substantially higher modulus of silk films compared with cartilage. This allows for the production of films that are much thinner than cartilage, with superior acoustic properties, but that still provide the same level of mechanical support as thicker cartilage. Together, these in vitro results suggest that silk membranes may provide good hearing outcomes while offering similar levels of mechanical support to the reconstructed middle ear.